CP: Chapter 6 Anxiety Flashcards
anxiety basic process
apprehension over an anticipated problem about future threat -> increases our preparedness to help avoid this potentially.
fear =
a reaction to immediate danger, the threat is happening right now
clinical descriptions of all anxiety disorders
interfere with functioning or cause distress
symptoms not bc of drugs or medical condition
symptoms for at least 6 months (or one month for panic disorder)
distinct from other anxiety disorders
specific phobia A=
disproportionate fear or anxiety about a specific object or situation. the person realises that the fear is excessive but still goes to great lengths to avoid the object or situation
specific phobia other criteria
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
B. always immediate fear/anxiety
C. always avoided or endured with intense fear/anxiety
D. out of proportion
soorten specific phobias
animals
natural environment (height, water)
blood-injection-injury
situational (flying, tunnels)
other
social anxiety disorder
persistent intense fear or anxiety about one or more social situations in which the individual
is exposed to possible scrutiny by others.
exposure to the trigger leads to intense anxiety about being evaluated negatively.
almost always avoid or endure with intense anxiety
panic disorder heel basic
Recurrent unexpected panic attacks
panic attack explanations
panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) symptoms occur
symptoms of a panic attack
- palpitations
- sweating
- shaking
- shortness of breath
- choking
- chest pain
- nausea
- dizzy
- chills or heat (soort griep)
- paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- fear of losing control
- fear of dying
other criteria panic disorder
At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
- A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of
exercise or unfamiliar situations).
dus 2 criteria panic disorder
recurrent panic attacks, unrelated to specific situations
at least 1 month of worry about having panic attacks
agoraphobia =
anxiety about at least 2 situations where it would be embarrasing or difficult to escape if anxiety symptoms occured:
- Using public transportation (e.g., automobiles, buses, trains, ships, planes).
- Being in open spaces (e.g., parking lots, marketplaces, bridges).
- Being in enclosed places (e.g., shops, theaters, cinemas).
- Standing in line or being in a crowd.
- Being outside of the home alone.
ov, open, closed, line/crowd, alone outside
ander criteria voor agoraphobia
situations are avoided, endured with great anxiety or need of companion
generalized anxiety disorder
A. excessive anxiety and worry more days than not, about multiple life domains (family, health, finances, work, school etc).
B. The individual finds it difficult to control the worry.
hoe lang GAD?
at least 6 mo
hoe lang panic attacks
at least 1 mo
generalised anxiety disorder C criteria
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
comorbidity in anxiety disorders
more than half of ppl with one anxiety disorder meet criteria for another in their lifetime
comorbidity leidt tot …
greater severity and poorer outcomes
which gender more vulnerable
women
waardoor vrouwen meer?
- more likely to rapport their feelings
- other lives (sexual assault)
- men: raised to believe to have more personal control
- women: more biological reactivity to stress than men (cultural + psychological)
taijin kyofusho
japan, fear of displeasing or embarassing others.
dus lijkt op social anxiety disorder, maar de focus ligt hier op het gevoel van anderen ipv het gevoel van jezelf
hoe heet het japanse social anxiety
taijin kyofusho
Mowrers two-factor model of anxiety disorders
- classical conditioning: learn to fear a neutral stimulus that is paired with an intrinsically aversive stimulus (UCS)
- operant conditioning: avoiding the CS -> relief -> avoiding responce -> behaviour aanpassen
3 brein onderdelen die een invloed hebben op anxiety
amygdala
medial prefrontal cortex
neurotransmitters
amygdala anxiety
assigns emotional significance to stimuli, involved in the fear circuit
anxiety = meer activity in amygdala tijdens threatening stimulus
medial prefrontal cortex
helps to regulate amygdala activity:
- extinguishing fear
- emotion regulation strategies
anxiety=less activation in medial prefrontal cortex
neurotransmitters
GABA inhibits anxiety, is downregulated.
serotonin helps modulate emotions, is disrupted
norepinephrine activates fight or flight (sympathetic nervous system), is increased
personality and anxiety
behavioural inhibition (early-appearing temperament characterized by strong reactions to novelty) and neuroticism are strong predictors for anxiety
neuroticism ook voor depressie
oke
cognitive factors that affect anxiety
- sustained negative beliefs about the future
- perceived lack of control
- attention to threat
- intolerance of uncertainty
perceived lack of control uitleg
traumatic events may promote a view that life is uncontrollable
little albert
rat, loud noise, began to cry whenever he saw the rat
prepared learning
a species-specific and inborn propensity to rapidly acquire a particular kind of insight.
door evolutie hebben we een circuit of fear -> learn stimuli quickly
social anxiety 2 factor model
negative social experience -> classically conditioned to fear similar situations -> avoiding -> relief -> operant conditioning -> avoidance behaviour is maintained
cognitive factors of social anxiety
unrealistically negative beliefs about consequences of social behaviour
they attend more to how they are doing in social situations and own internal sensations than other people do
panic disorder neurobiological factors
locus coeruleus in fear circuit -> norepinephrine production -> triggers sympathetic nervous system activity -> panic attack?
behavioural factors of panic attacks
panic attacks are triggered by internal bodily sensations of arousal -> classically conditioned responseto situations that trigger the anxiety or the internal bodily sensations of arousal
= interoceptive conditioning
cognitive factors in panic disorder
panic attacks develop when a person interprets their body signals as inevitable doom -> thoughts increase anxiety -> physical sensations -> vicious cycle
anxiety sensitivity index
extent to which people respond fearfully to bodily sensations, can predict the onset of a panic attack
genetic factors of panic attack
genes may shape stress responses and hypersensitivity to somatic changes, which could increase risk of panic disorder
fear-of-fear hypothesis
agoraphobia: bang om bang te worden, dus je krijgt anxiety over de consequences van anxiety in public
ethiology of GAD: contrast avoidance model
worrying -> avoiding unpleasant emotions they think are worse than feeling anxiety. -> chronic state of worry and distress, more stable emotional state than very intense responses to stimuli (voelt veiliger)
The Contrast avoidance model (CAM) suggests that individuals with generalized anxiety disorder (GAD) avoid negative emotional contrasts (shifts) by creating and sustaining negative emotions through worry, and the main fear in these individuals is negative emotional contrasts.
anxiety treatment vaak…
exposure!
CBT exposure
list of triggers
exposure hierarchy
steeds iets meer triggering gaan
steeds meer challenge
verschillende features van de feared object
verschillende settings
social anxiety treatment
roleplay, small groups, gradually more public. teach them to stop using safety behaviours
treatment of panic disorder
panic control therapy PCT -> based on the tendency to overreact to bodily sensations. exposure to sensations associated with panic, practice with coping
generalizes anxiety disorder
- relaxation techniques (behavioural)
- strategies to help tolerate uncertainty (cognitive)
which drugs can we use
benzodiazepines
antidepressants
medication to enhance learning during treatment
d-cycloserine
